The URL can be used to link to this page

2017_0525 IRRIGATION DOMESTIC FIRELINE V The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: L_QKes�'�Q� (� C�nnell ��Q /1/Cco��j;�c� 7.5'�19 CONTACT PERSON/PHONE: � �� 0�/ �CI 3�7 LOCATION OF SERVICE: �S'�me The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �u educed Pressure Principle �Reduced Pressure Principle-Detector oubleCheckValve -Double Check-Detector �PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker /l Manufacturer_�/�'�ES Model Number �,DQQ�5 Size� Located At C f�,t.��1 e u.��,t�� Serial Number v2 L'/� �L'i-�l Is the assembly installed in accordance with manufacturer recommendations and/or local codes? iJ�'S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight'� Closed Tight X psid psid psid Leaked' I Leaked'. Did not open _ Did not open �� Leaked'�'�� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight �1 ClosedTight�� psid psid psid Test gauge used: Make/Model��L(�`.�JCS� g�f 6�`" + SN: � (��/(7 �� n Date Tested for Accuracy: ,�J��z�j 7 Remarks: The above is certified to be true at the time of testing. Firm Name �{��(L��, Firm Address j�d�3 /�C�7Gr�,�u!t �(C-C�� Certified Tester(pr�nt)� C•`rc��d�� Certified Tester(signature) Firm Phone#-��,� � �7 U'�1 Cert.Tester No,�pGt(�(j 1`�(p(�r� Date�� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) n I r� MAILING ADDRESS: ��JCe S�l� �n��n�J/ �� p�('.��i"�� SQ�q CONTACT PERSON/PHONE: ��2 �D�j �1� 3 0 � � LOCATION OF SERVICE: �� G The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �Reduced Pressure Principle � Reduced Pressure Principle-Detector �ouble Check Valve �Double Check-Detector �PressureVacuumBreaker -JSpi11-Resistant Pressure Vacuum Breaker �/ Manufacturer �,S Model Number ,�d�� Size�_ Located At��/� YUojyt �� ! Serial Number �� 7 7 Is the assembly installed in accardance with manufacturer recommendations and/or local codes? �G 5 Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight;� Closed Tight� psid psid psid Leaked��. ; Leaked. 1 Did not open . � Did not open ' Leaked. 1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight_ ClosedTight _' psid psid psid Test gauge used: Make/Model�V�r'(�P5 r ��1�� SN: ��( �l [� �.5�� Date Tested for Accuracy: ,2 ,��> 7 Remarks: The above is certified to be true at the time of testing. FirmName��(�'�� G/ylr✓( � FirmAddressPor3�zc�� ►��U�n� T�7�a�� Cerrified Tester(pr�nt)� r��1/��l',�d(l�Certified Tester(signature) � Firm Phone#��Z�,21 � OC� Cert.Tester No�/�840 �(�r��_Date � / * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE �/ The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) 7� / � J MAILING ADDRESS: ��K s��rl E � C v�2��,r�,��ell � � �� CONTACT PERSON/PHONE:�7;Z 2 D� � �� 9'�o LOCATION OF SERVICE: S,��' The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY R duced Pressure Principle ��Reduced Pressure Principle-Detector �oubleCheckValve �iDouble Check-Detector �PressureVacuumBreaker =�Spill-Resistant Pressure Vacuum Breaker Manufacturer��Tin,G S Model Number�G�G'�,� � Size ,,�I Located At Y]�P �r/"P9�S�n� ��/� .�. Serial Number ��1C�d ��' Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�j� psid Held a��psid Opened at Opened at Held at Initial Test Closed Tight�' Closed Tight .✓� psid psid psid Leaked�, Leaked�. ; Did not open .i Did not open �� Leaked�� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight i 1 Closed Tight ] psid psid psid Test gauge used: Make/Model /�/`��G'�� SN: ��G��Q�� Date Tested for Accuracy: 02.�� 7 l 7 Remarks: The above is certified to be true at the rime of testing. Firm Name�C'. f�'� C��.,t1![ Firm Address��l��(7 r�C'Vl n_!��7 Certified Tester(pr�nt)��Yc lc:C.SC�OL�� Certified Tester(signature) Firm Phone#� 7 z �P� � � �� Cert.Tester No.,��C�C�I�$�� J� Date�,,21� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-Ciry Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) � p MAILING ADDRESS: L� s�� 2 na C�D D'�I �0 2,U �v fl D��'CC�1`7S d I � CONTACT PERSON/PHONE: g'7 1 ��Su 1�r 9 4 c� LOCATION OF SERVICE: �r The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �Reduced Pressure Principle r'Reduced Pressure Principle-Detector GJ�ouble Check Valve �Double Check-Detector -��PressureVacuumBreaker �'Spill-Resistant Pressure Vacuum Breaker Manufacturer �,�yt e S Model Number o�(?f� t��_Size�_ Located At Y'l Sf' 1� I�D(��/l �� Serial Number ��_ I s t h e a s s e m b l y i n s t a l l e d i n a c c ar d a n c e with manufacturer recommendations and/or local codes? �S' Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at��psid Held at�� psid Opened at Opened at Held at Initial Test Closed Tight�� Closed Tight.,✓' ps�d psid psid Leaked'.1 Leaked'J Did not open I Did not open __ Leaked�_! Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Neld at Repair ClosedTight l ClosedTight�' psid psid psid Test gauge used: Make/Model��` /<',�t �' �� SN� D��L��g-5� Date Tested for Accuracy: � /�/1 7 Remarks: The above is certified to be true at the time of testing. Firm Name/•�/� f1�0 �(l M/L!� Firm Address�,��.��y'.ti0C'V�� ' Q y,1 Certified Tester(pri�t)� C Y'o/C�. �(',�6�CS� Certified Tester(signature) � � , Firm Phone# ��Ce�Z l 7OU Cert.Tester No��S�� Date l� �� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) I MAILING ADDRESS: G.��:ke ��e�l�ne%��'�-4 /�l,C.�a,�e/11�i� �S�/ � CONTACT rERS�N/PHONE: CI )2 � —�rr�c�T�—�= LOCATION OF SERVICE: ��, A The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY JReduced Pressure Principle I Reduced Pressure Principle-Detector �ouble Check Valve 1 Double Check-Detector =1PressureVacuumBreaker ��Spill-Resistant Pressure Vacuum Breaker ,1 �IC Manufacturer N v►�1 �5 Model Number �.� �� Size �� Located At '�� f''Y �U C in � � � Serial Number �L��l g Is the assembly installed in accordance with manufacturer recommendations and/or local codes? %✓ Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held a�� psid Held atv�-'L psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight/ psid psid psid Leaked Leaked . Did not open ' Did not open Leaked Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight�� I Closed Tight :: psid psid psid Test gauge used: Make/Model��<�hJ�i 1` Sy7�^ �i SN:��0�/�l_')_�'Sf L� Date Tested for Accuracy: �� /l 7 Remarks: The above is certified to be true at the time of testing. Firm Name�P 1�� D��_Firm A ddress�(�,�t/Z�7(1��('l l�� /X ��1 �" 7 Certified Tester(pr?ntl� �7'e��f�'�G�Of�� Certified Tester(signature) --� Firm Phone#�/ �,L(,� � �7�'C� Cert.Tester No./`S/�C%Ci(I j"�(Q�� Date -�/�5�.�—. * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) MAILING ADDRESS: � cx�Ces'� o� t °E �'n ��el� � �, �'��J1� 7�a l S CONTACT PERSON/PHONE: �2 3 0�l �/ ,% 3 0 LOCATION OF SERVICE: ,� - r� The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ��Reduced Pressure Principle IReduced Pressure Principle-Detector ��ouble Check Valve �-�Double Check-Detector I,Pressure Vacuum Breaker 'Spill-Resistant Pressure Vacuum Breaker Ij Manufacturer �IY�C�� Model Number � U �U � Size�_ Located At `✓I S�e i� �OC�,/►� /�/G � Serial Number C�� J' �- � Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �� 5 Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight / psid psid psid Did not o en . ' Did not o en Leaked. Leaked. l Leaked P p Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight' Closed Tight I psid psid psid Test gauge used: Make/Model/�/ ,',T ,1�; Ps1- �y� �� SN: C1�yl?�S�U Date Tested for Accuracy: �j/� Remarks: The above is certified to be true at the time of testing. FirmNamey�/�'1i`y'U �U��,. Firm Address�d�� G'rG�l��^V%i2c �j� 7�C�9� Certified Tester(pr�nt��Yv��-Sc/�G'0�� Certified Tester(signature) ,r � Firm Phone#�7�(o,Z/ �7QCJ Cert.Tester No.�'f�d�� g Date .�� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White- City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE �/ The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: c �' C C� ' �'� CONTACT PERSON/PHONE: � � v LOCATION OF SERVICE: _�Sti�,�. ^ The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY '�`Reduced Pressure Principle 1Reduced Pressure Principle-Detectar �'Double Check Valve Double Check-Detector �PressureVacuumBreaker 1Spi11-Resistant Pressure Vacuum Breaker II Manufacturer ��'�J/�S Model Number �C�C1 C��3 Size� Located At Y' � � Y ►� uo>r. �� G Serial Number�� 9y Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at � psid Held at�i 3 psid Opened at Opened at Held at Initial Test Closed Tight�: Closed Tight .�! � psid psid psid Leaked�' Leaked. ' Did not open Did not open . Leaked-_ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight ClosedTight i psid psid psid Test gauge used: Make/Model i��l,✓�S�" ��:S SN: ��L�yO �� Date Tested for Accuracy: � 117 f l� Remarks: ,,� c�iz,�i� i,r u,�n s�,/_�h �^ Y� n�t� The above is certified to be true at the time of testing. Firm Name �I eI'Y'D �Oin/rJ Firm Address I�Or3izr� ,'�'� v�� %Ke� 7��c1�J' Certified Tester(print)�c r�l�.�hGC� Certified Tester(signature) - Firm Phone# 7 7.� <0.7 I $70 U Cert.Tester No.�t��%6 6�'(� (��% Date��5 / / � * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE V The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: L� E 3)� E (r�Co�J(oa0l�/�C � l�,__Z_SoLy CONTACT PERSON/PHONE: ��3 U�-�/ y 9 3 t3 LOCATION OF SERVICE: �f �-h �' The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �R�uced Pressure Principle -1Reduced Pressure Principle-Detector ;�'Double Check Valve ' �Double Check-Detector �PressureVacuumBreaker 1Spi11-Resistant Pressure Vacuum Breaker � /� Manufacturer h'1^ $ Model Number ,�(LU� Size Located At��(? 1� (�D�1/'►'1 ��C' � Serial Number L�D��.��_ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �CS Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at��psid Held at��psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight� psid psid psid Leaked ' Leaked_.; Did not open Did not open : ' Leaked. Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight�� Closed Tight� i psid psid psid Test gauge used: Make/Model��''��c� rf��/5',�j SN:O�C�y L%�Jf � Date Tested for Accuracy: i� � 7 �J�7 Remarks: The above is certified to be true at the time of testing. Firm Name /_!%�E ��2tL�J Firm A ddress Pa�1zG� Gr�a��n�/)r�� Certified Tester(print) � G!'U��G�O� Certified Tester(signature) -�/ �� Firm Phone# -/ 7 � 7�� Cert.Tester No�p�aD�� Date -S� � * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-Ciry Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE�� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) , MAILING ADDRESS: L-� C 1 � � � � �� v� CONTACT PERSON/PHONE: } L L� LOCATION OF SERVICE: cF .,�,� , � The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY " R duced Pressure Principle IReduced Pressure Principle-Detector I-�ouble Check Valve :Double Check-Detector lPressureVacuumBreaker iSpill-Resistant Pressure Vacuum Breaker 1( Manufacturer �,S Model Number �(�C�(J� Size�_ Located At �/;�� r f�'0 0/�'t �� Serial Number �fJ�1�,�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? � Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�psid Held at� ( psid Opened at Opened at Held at Initial Test Closed Tight✓'� Closed Tight � psid psid psid Leaked ' Leaked I Did not open Did not open Leaked Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight'' Closed Tight _' psid psid psid Test gauge used: Make/Model V� ' P � � SN:��U �S d Date Tested for Accuracy: lZ Remarks: The above is certified to be true at the time of tesring. FirmName,�i? �1'0 Um�'j Firm Address��l��E',��Y�7 C(�hG /�, �� j/�� Certified Tester(pr�nt), C rG l��I(J� Certified Tester(signature)�^ � � � �?� 1 �7 � � ' S Firm Phone# (.�'� �� Cert.Tester No.��v ��C� Date *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) �" " 9 MAILING ADDRESS: L�-/E-�31l`�� C��f�E'�/�0 2��V CooJt-�I/� ��Q�� CONTACT PERSON/PHONE: 7 J. �D_�l 3C' LOCATION OF SERVICE: ,S;.,� n The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �� duced Pressure Principle IReduced Pressure Principle-Detector ouble Check V alve 'Double Check-Detector '�PressureVacuumBreaker lSpill-Resistant Pressure Vacuum Breaker ManufacturerT��' S Model Number ��C�C��_Size �.��1 Located At �('1�S(' Y YD��h��• � Serial Number �O�J f y�j'�_ I s t h e a s s e m b l y i n s t a l l e d i n a c c o r d a n c e w i t h m a n u f a c t u r e r r e c o m m e n d a t i o n s a n d/o r l o c al codes? ��S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at/�psid Held at�� / psid Opened at Opened at Held at Initial Test Closed Tight/ Closed Tight I' psid psid psid Leaked ' Leaked_; Did not open . Did not open Leaked Repairs/ Materials Used � Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight� i Closed Tight-��_ psid psid psid Test gauge used:Make/Model �/��'� ��5 S SN:Q�y D �.� �' Date Tested for Accuracy: � /� 7 �/ 7 Remarks: The above is certified to be true at the time of testing. Firm Name��'1��,�/yr Firm Address�(�/�1��0 ��'c�d��/!i-t e /�c ��d 1��` Certified Tester(pr�nt) ��1^tJl(;��L (J tl�! Certified Tester(signature) — Firm Phone# / � D 2.� � ?Q� Cert.Tester No.��`'1�D0 �'(o� �y Date � �5 l * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) p MAILING ADDRESS: ��' S;�2� �"�9��-�� Q �U Cot�DL�J�,C �„ d / �l CONTACT PERSON/PHONE: _��-i `�j� fa LOCATTON OF SERVICE: S„ > P The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �R duced Pressure Principle -iReduced Pressure Principle-Detector ; �ouble Check Valve � '��Double Check-Detector �PressureVacuumBreaker ' Spill-Resistant Pressure Vacuum Breaker �j �l� Manufacturer�`TfY) �.S Model Number � �p�1� Size Located At r S(�,��'�G'��/✓/c: ��_Serial Number �G� /�'/�'�] Is the assembly installed in accordance wrth manufacturer recommendations and/or local codes? � � Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�psid Held atl�psid Opened at Opened at Held at Initial Test Closed Tight.�' Closed Tight �'' psid psid psid Leaked '' Leaked-J Did not open . Did not open Leaked ; Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight �� Closed Tight � psid psid psid Test gauge used:Make/Model/r�i G��51` ��7 r S SN:�$��C'�5 f'✓ Date Tested for Accuracy: _� .2 7 �/ 7 Remarks:��'��D�^c�S/'�� !� �' Y�'�DF�� Y _ � The above is certified to be true at the time of testing. Firm Name/`��°f��' CG>n yn� Firm Address��`�/�l�-� C-'Ycu��4�i /�� 'L� 4� Certified Tester(print�BYlJ�G��hl�G�� Certified Tester(signature) Firm Phone# %�i� �Z1 87G�G� Cert.TesterNo.��G�D��r��'� Date�J�'� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDREN/P ON�� CONTACT rERS• �_� � LOCATION OF SERVICE: �' C' The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY -iReduced Pressure Principle �lReduced Pressure Principle-Detector �oubleCheckValve -Double Check-Detector ' ':PressureVacuumBreaker lSpill-Resistant Pressure Vacuum Breaker � � Manufacturer �jyi � Model Number �L�Q� �� Size Located At� r1��"�9��6�/� Serial Number �/�l1% � �l�._ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? P. Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at/i 7 psid Held�� psid Opened at Opened at Held at Initial Test Closed TightL!' Closed Tight� psid psid psid Leakedi I Leaked I Did not open �7 Did not open _ '�� Leaked�� '�� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight'= ClosedTight _� psid psid psid Test gauge used:Make/Model �i G(�J�T �y.�� SN: C) �C?��5� Date Tested for Accuracy: ��.7 � � Remarks: The above is certified to be true at the time of testing. FirmName��'�J('�7 ��,�,�_FirmAddressf Q��lo��t��i'c:0-v��/�(' /��Q/�T Certified Tester(print).��f ur�l'��.�tG�o� Certified Tester(signature) Firm Phone# % 7„Z �� 7 �U Cert.Tester No.�Qd� �e�a � Date .� � 1 � * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy � Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE ✓ The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) � D p MAILING ADDRESS: L.a,�eS��cC��Cv D�e�� p iZG'�• C a D))^�I/�G( ��U� q CONTACT PERSON/PHONE: �j�7 Z �('� J ��3a LOCATION OF SERVICE: S�, m � The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �Re uced Pressure Principle "1Reduced Pressure Principle-Detector ub1e Check Valve �1 Double Check-Detector �PressureVacuumBreaker ,Spill-Resistant Pressure Vacuum Breaker n � Manufacturer�I'�'1 C�S Model Number f�L�L�� Size� Located At ��,5'p ?� 1"C�d �/G' �� Serial Number (�� _ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? E� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at � l psid Held at�psid Opened at Opened at Held at Initial Test Closed Tighy� Closed Tight� psid psid psid Leaked ' Leaked , Did not open _ ' Did not open . Leaked. Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight I ClosedTight___� psid psid psid Test gauge used:Make/Model ` . l� ` SN: U��J��S G� Date Tested for Accuracy: � �7�l z Remarks: The above is certified to be true at the time of testing. Firm Name��?��'d �G/y�/1�� Firm A ddress��07 �Y'f�'I^�`L j�L��l � ! Certified Tester(print) ,)e rv/�X,if''�j�'(�/"` Certified Tester(signature - Firm Phone# y �-2.C��Z1 D (UL� Cert.Tester No.��OG�� f �'j Date� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS ** USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE `� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) j _I MAILING ADDRESS: L-A-��S��G�C� Cvi7��C��Q�Q� �r��l �U ��Q�� CONTACT PERSON/PHONE: '� G LOCATION OF SERVICE: .- C The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �❑R uced Pressure Principle �-7Reduced Pressure Principle-Detector oubleCheckValve ��Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker �� /( Manufacturer�nl�Yt C S _ Model Number ,��____��) Size�,_ Located At Y ��Str ►�bU/z2 �jc f�Serial Number 6��,3 �_ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �P S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�psid Held at�psid Opened at Opened at Held at Initial Test Closed TightE�' Closed Tight,B' psid psid psid Leaked� Leaked� Did not open '� Did not open '�7 Leaked'.:i Repairs/ Materials Used Heid at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight❑ psid psid psid Test gauge used:Make/Model ��t`G��}` �7�'�SN: C� � (��,/(),`�jf l� Date Tested for Accuracy: �l�� / �7 Remarks: The above is certified to be true at the time of testing. FirmName/''( � f"�L�' �G'/y�f'1'� Firm Address�a�,��f��o� �G.,D�i/t/'1 G ��U y� )� � Certified Tester(print) J��Y��C�'lG'Q� Certified Tester(signature) � ' Firm Phone# ��'� � ��G� Cert.Tester No��QL��F(C � Date . � * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE " The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) �� MAILING ADDRESS: L�,f.��f�(.c C� '� � cI�� C/�l�l� CONTACT PERSON/PHONE: 7 2�c�Y_�/�i � LOCATION OF SERVICE:�4 �-�' The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑R duced Pressure Principle �Reduced Pressure Principle-Detector �ouble Check Valve U Double Check-Detector ❑PressureVacuumBreaker `�Spill-Resistant Pressure Vacuum Breaker f� Manufacturer �!'!��.,� Model Number�� Size� Located At �" / �SG r j''G G /fi �7 Serial Number Q ��7 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? `'S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�psid Held at/i�psid Opened at Opened at Held at Initial Test Closed Tight:;r Closed Tight � psid psid psid Leaked' 1 Leaked'J Did not open '=� Did not open f.l Leaked� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight� Closed Tight i l psid psid psid Test gauge used: Make/Model �v�i` /n/!�.�1=�S `� SN:o�C�i y�� SL� Date Tested for Accuracy: �/Z�/'? Remarks: The above is certified to be true at the time of testing. Firm Name��'��(� l_ �%�'�h�_Firm Addres�0��f��o 7 rY�,,DCGsr�'tGlK71��f� Certified Tester(print) ��ro�(� (�eJc9� Certified Tester(signature) Firm Phone# �7.�c�Z 1 ��L�� Cert.Tester No�C G��c�� Date * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE�� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) � / � P ( . v MAILING ADDRESS: � z ' Co CONTACT PERSON/PHONE: t7 ' C� LOCATION OF SERVICE: ,Sr- v The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �❑ duced Pressure Principle CiReduced Pressure Principle-Detector ouble Check Valve ❑Double Check-Detector ❑PressureVacuumBreaker '�Spill-Resistant Pressure Vacuum Breaker a t/ Manufacturer��,,�C� S Model Number zc'�L�O/> Size�_ Located At �r� �PY �Q�/�'� �1� �^� Serial Number ��l� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at � 7 psid Held at�psid Opened at Op�ned at Held at Initial Test Closed Tightl� Closed Tight,1� psid psid psid Leaked❑ Leaked�� Did not open ❑ Did not open i 1 Leaked�' Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight❑ psid psid psid Test gauge used:Make/Model /l'1%(�� r gyj'"� SN:�?��yLf�,j�C�%� Date Tested for Accuracy: ,Z �Z� �� 7 Remarks: The above is certified to be true at the time of testing. FirmName�C� �ru �o/vl),.�, Firm Address��4/3/,7(�7 �+�YC��,�cri nC/X ��C� �y Certified Tester(print)-��'C+l CY��C'G�' Certified Tester(signature) Firm Phone#�7.� CQ�� ?C'� Cert.Tester No�l��dQ��7 Date � � * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE � The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) J MAILINGADDRESS:�a��S��Gf�� C�L��2.� � ��/�� .��i� CONTACT PERSON/PHONE: 9�� L'z�� 3C� LOCATION OF SERVICE: S�rh � The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑ duced Pressure Principle ❑Reduced Pressure Principle-Detector ouble Check Valve �Double Check-Detector � IPressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker /�r�'1 � !l ManufacturerT� 5� Model Number ,��i�GCi��_Size�_ Located At y 1� SP �l' �''t�(�,t�2�1� Serial Number �� G' Is the assembly installed in accordance wrt manufacturer recommendations and/or local codes?��'S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at��! psid Held a��psid Opened at Opened at Held at Initial Test Closed Tight�' Closed Tight v✓ psid psid psid Leakedf� Leaked:� Did not open Cl Did not open ❑ Leakedf� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight i�l Closed Tight❑ psid psid psid Test gauge used:Make/Model/'j>��(�J�sr �yS S SN:��p��'�S��' Date Tested for Accuracy: .�Z �� l/ � Remarks: The above is certified to be true at the time of testing. FirmName��1`✓'�; Coh•l yYt : Firm Address/ 4��i�p ��1'rc�,��;hG'�� /��l�i'/�� Certified Tester(print)�G)^o��C/t,6b��Certified Tester(signature ^ � Firm Phone# ��,�1 D ��U Cert.Tester No.��1��' Date Jr ��l� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) , MAILING ADDRESS: �' / � � ?� CONTACT PERSON/PHONE: �i 7 2 3C?�/ �� ll LOCATION OF SERVICE: S��,a �' The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle ❑Reduced Pressure Principle-Detector �oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker �GUG� � 1 f Manufacturer ��.� Model Number Size Located At �l��(`' 1� ��C�11'i ��G l 7 Serial Number (��_ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? uC Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve l st Check 2nd Check Held at�t I psid Held at �7 psid Opened at Opened at Held at Initial Test Closed Tight�' Closed Tight �� psid psid psid Leaked� Leaked❑ Did not open ❑ Did not open ❑ Leaked�-i Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight�I psid psid psid Test gauge used:Make/Model�� r Gt �GS� �� SN:(i�C�� Date Tested for Accuracy: ,,�1�7_�/� Remarks: The above is certified to be true at the time of testing. Firm Name��r�' C�h'�/�i �� Firm Address��1��Y��Ut �C/�7�� Certified Tester(print) -��"O �GC�C�1.4Q� Certified Tester(signature) — Firm Phone# �� D �� Cert.Tester No.�J��'U(,��(�( � Date � � � * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE V The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) � > MAILiNG ADDRESS:��'�C l�✓ v o0 .�l ��,C)� u�v�/I��S� �� CONTACT PERSON/PHONE:T 2� 1�_�� 3 Z1 LOCATION OF SERVICE: 5��/' The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �❑R duced Pressure Principle �lReduced Pressure Principle-Detector oubleCheckValve LiDouble Check-Detector ❑PressureVacuumBreaker `7Spi11-Resistant Pressure Vacuum Breaker Manufacturer l7/� �S Model Number �� _Size�� 1 Located At Y�5`�"� r'��1/� l.� ��, ��Serial NumberL�C��l�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at// � psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight`r!'` Closed Tight�� psid psid psid Leaked'� Leakedf-1 Did not open '�� Did not open 7 LeakedC] Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight❑ psid psid psid Test gauge used: Make/Model/��/,.�'�,S 1"��jr —� SN:��U�CG ��C� Date Tested for Accuracy: ,�a 7�/ � Remarks: The above is certified to be true at the time of testing. Firm Name ��"I�a �� %►'1/1? .- Firm A ddressl�C1�IZ��+Yc�,��v�tc', !��'�7� Certified Tester(print)�C�'v[�j��G� Certified Tester(signature) � � Firm Phone# / 7�(,�'�� ?� �G'L� Cert.Tester No.��OC��' �C Date �(�� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE V The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILINGADDRESS:,��kes�� C�ca�Qf1 f2G'/L�� Lc��►oc1�lZ� ��s�%�S CONTACT PERSON/PHONE: �Z,'�, `�G �^��/�i' '�C� LOCATION OF SERVICE: �'�,..,��. C The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C7�uced Pressure Principle C1Reduced Pressure Principle-Detector �'Double Check Valve ❑Double Check-Detector �-]PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker I( Manufacturer /� �� Model Number ��'��1� Size�_ Located At��5 C:'.� J�c� 0 YY► �/� � � Serial Number ��„�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes?�,�jf Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�psid Held at/i psid Opened at Opened at Held at Initial Test Closed Tightl� Closed Tight � psid psid psid Leakedn Leaked❑ Did not open ❑ Did not open I�� Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight❑ psid psid psid Test gauge used:Make/Model��GC 1��5� ,�� SN: C��L.'L��' �� Date Tested for Accuracy: � �.�7 �� 7 Remarks: The above is certified to be true at the time of testing. FirmName /°l�t+�d ��/3^ii'1 ° Firm Address�C'�� 7�i,,OcV//1� 7�� J�j� Certified Tester(print)��lL��C� t?Cd� Certified Tester(signature) Firm Phone# T /,Z�,2� �7 �,� Cert.Tester No1JrGC'G��(�(� Date .��1�� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE � The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) � ��,� � � � ,2,L� l�� C �lI c� 7�C' l`I MAILING ADDRESS: ��j�� A r �� ° °��= CONTACT PERSON/PHONE: �],Z,3 U`� ��' �� LOCATION OF SERVICE: �r n � The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle �Reduced Pressure Principle-Detector �Double Check Valve ❑Double Check-Detector C1PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker f/ Manufacturer��ivl/' � Model Number �U(�U l3 Size � Located At Y I �('�Y ,Y[��G�_ �� Serial Number�r G� �.L Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �!'S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker • Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at/�psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight�' Closed Tight� psid psid psid Leaked❑ Leaked'�-'� Did not open '�1 Did not open J Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight� Closed Tight❑ psid psid psid Test gauge used:Make/Model��,��.(�'CS r��'� SN:�?�U'7��--'� Date Tested for Accuracy: .2/Z.711.� Remarks: The above is certified to be true at the time of testing. FirmName/•c P�fG' ��/��I. Firm Address��,�1.2��Ye.� ,'>� �X 7�C� l� Certified Tester(print)��°�d��t�C��=t�k� Certified Tester(signature) � Firm Phone# �� C�� Cert.Tester No��'��'�'TI _Date �� f * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE V The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: �, C Si��G Ca I Z� . Cc� ��d� S�f � CONTACT PERSON/PHONE• �1?2. ,3v �l 4�3b LOCATION OF SERVICE: a�i„n�e The backflow prevention assembiy detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �❑ educed Pressure Principle !�Reduced Pressure Principle-Detector ouble Check Valve ^1 Double Check-Detectar ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker �`t'�^'��S Model Number �`f Manufacturer ? ��O13 Size Located At Y/�S��Y Y��r''1 /J�� .2 � Serial Number 0�� /� l 7 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�� psid Held at� v psid Opened at Opened at Held at Initial Test Closed Tighti�l� Closed Tight � psid psid psid Leaked'�-; Leaked�-1 Did not open �:� Did not open !7 Leaked!� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight n Closed Tight❑ psid psid psid Test gauge used:Make/Model��'��/15 � ��.5 `j SN:��(�1�%f��G Date Tested for Accuracy: � / ��! � Remarks: The above is certified to be true at the time of testing. Firm Name �� l��t� �d/+�y��_Firm A ddress/"ia��,z��9't'�/�!lE I1G � �� `�% Certified Tester(print�G�ro�(�,��(�Pk Certified Tester(signature) Firm Phone# � �� Cert.Tester No.�f�G��Date � /� �l * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) /� MaILIrrG aDD�ss:�ti�� 5 4 dE �C��n�ll ��tl� �AD�,I�K� �..��J � CONTACT PERSON/PHONE: ' 3 C�'`� � 12 LOCATION OF SERVICE: �' The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑R duced Pressure Principle ❑Reduced Pressure Principle-Detector �ouble Check Valve �Double Check-Detector i-lPressureVacuumBreaker ��lSpill-Resistant Pressure Vacuum Breaker � , �� Manufacturer� �,�_Model Number ,�U� �3 Size�_ Located At '�i�� Y t1C>fY J�r��Serial Number G�� Is the assembly installed in accordance with manufacturer recommendations and/or local codcs? � Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at oZ�� psid Held at!�psid Opened at Opened at Held at Initial Test Closed Tight�' Closed Tight,� psid psid psid Leakedf I Leaked-1 Did not open ❑ Did not open ❑ Leaked� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight u Closed Tight❑ psid psid psid Test gauge used:Make/Model�/�/ �I�LP��y 7 SN: !� v'�(,� �� Date Tested for Accuracy: � 2 7�/ 7 Remarks: . The above is certified to be true at the time of testing. Firm Name�" �Yo C..- Gf7'1 � � Firm Addressf U�3��G7 C��n� (�` ?��7� Certified Tester(print),�f. Y'(�/t(✓,�� Certified Tester(signature) Firm Phone#%��f D ��C� Cert.Tester No.��8�� Date * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS � White-City Copy Yellow-Customer Copy Pink-Tester's Copy _ // IRRIGATION DOMESTIC FIRELINE The following form must be completed far each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) l � � MAILING ADDRESS: �c�� f"�� ` C� ' � � �� CU � r� 7 G CONTACT PERSON/PHONE: ? �' LOCATION OF SERVICE: SG. m G The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑R duced Pressure Principle ❑Reduced Pressure Principle-Detector �oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker R fl Manufacturer ��CS Model Number �_�__ C'��'/� Size�_ i Located At '?(�1 ,�j �� '�1 C7/Yt �T,,,�T Serial Number��/ � � Is the assembly installed in accordance with manufacturer recommendations and/or local codes? ��f� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�� psid Held a�/�psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight,,� psid psid psid Leaked'�7 LeakedJ Did not open ❑ Did not open ❑ Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight� Closed Tight❑ psid psid psid Test gauge used: Make/Model��TG�'�S�O L�� SN:��1��r��' Date Tested for Accuracy: s� /•2 7 �7 Remarks: The above is certified to be true at the time of testing. Firm Name�G't l�G� �C'/l'�J'�'? Firm A ddressl�L'�fZ�7 C�"Y��/2G� ��-"/C � �` �J� � Certified Tester(print}��`� ��/��`1� Certified Tester(signature) �"` Firm Phone# / ��C Cert.Tester N��L'l:�� Date ��'�'�� *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE v The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) �` > MAILING ADDRESS:L.�t`.0 Sj��e C`'� C��PC Il��J� Cc�.��/ �� S�I c1 CONTACT PERSON/PHONE:�7 2 3�T� S� LOCATION OF SERVICE: S- � The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C]R duced Pressure Principle iReduced Pressure Principle-Detector �ouble Check V alve ❑Double Check-Detector C7PressureVacuumBreaker [_�Spill-Resistant Pressure Vacuum Breaker � ,2 U L C.�l� Size� Manufacturer �f'+'� � 5 Model Number Located At �'i�S`Y rU a� /��n,�y Serial Number��D�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? G Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�psid Held at°2'� psid Opened at Opened at Held at Initial Test Closed TighL�' Closed Tight � psid psid psid Leaked❑ Leaked'�' Did not open `-'. Did not open 7 Leaked�� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight n psid psid psid Test gauge used: Make/Model ,�+��!�� 5� SN: Q��y��.s �� Date Tested for Accuracy: �, ��z � 7 Remarks: The above is certified to be true at the time of testing. FirmName��'�J"t? �� Firm Address/�Q�/�ZCa7 C��pc�1 t/.�G lX7�C��J' Certified Tester(print ��'(? Certified Tester(signature) /' , ;p C L Firm Phone# �� 1 5j�L'G� Cert.Tester Nol��, �G� / Date / /�� f� *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE ✓ The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) � �� MAILING ADDRESS: LG��,si � C8 ��Def��i�" CONTACT PERSON/PHONE:��3 U� � 3�✓ LOCATION OF SERVICE: ��c :n � The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �❑R duced Pressure Principle ❑Reduced Pressure Principle-Detector oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer ,�,�'I G} Model Number �(��iC�� Size �,�,1( Located At Y'� `s�r d''�D rr� J��T,�4S Serial Number Q� �� Is the assembly installed in accordance with manufacturer recommendations andlor local codes? GS Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at! � ` psid Held at��psi Opened at Opened at Held at Initial Test Closed Tighti%� Closed Tight� psid psid psid Leaked� Leaked'-' id not open ❑ Did not open '� LeakedL: Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight�7 ClosedTight❑ psid psid psid Test gauge used:Make/Model�f,,�!✓("S7"�y��_� SN: �� Q �� (� Date Tested for Accuracy: ,��2 7 /� � Remarks: The above is certified to be true at the time of testing. Firm Name,�'�� o CaiYI,/y� Firm A ddress�Q�1�G� Y D. ��,�G �� /7 Certified Tester(print)��r a �CC�/�P�� Certified Tester(signature) ✓ - Firm Phone#�7�,�1 �7�� Cert.Tester No.�/ l��Co 7 Date �( *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE V The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS:1�c �C, ; �� v p��Il �z�/ll. G�pp�/�/� �j�.�/� CONTACT PERSON/PHONE: � �a !a�l � " 3� LOCATION OF SERVICE: 5��E-^ G The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle ❑Reduced Pressure Principle-Detector �oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker '�Spill-Resistant Pressure Vacuum Breaker !l Manufacturer �,[j�I 6. S Model Number ��C�'l,� Size�_ Located At�(' l S� Y ��U�_/�/� � �G Serial Number 6 � v a��2 I s t h e a s s c m b l y i n s t a l l e d i n a c c o r d a n c e w rt h m a n u f a c t u r e r r e c ommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check � Held a�� psid Held at � psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight Cl psid psid psid Leaked'.7 Leakedy'�' Did not open ❑ Did not open ❑ Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight n Closed Tight❑ psid psid psid Test gauge used:Make/Model �>�UV�$�` �`�'J "s SN:��v y�� Date Tested for Accuracy: �� Remarks: �v'c. �'� �S J�C � �Y � The above is certified to be true at the time of testing. FirmName� "(�'rYG C'}vt,�I Firm Addressl�'61� ��Crc,,��>n��n �ICS� �� S' Certified Tester(print�c��TC�'�G`C� Certified Tester(signature) Firm Phone# �7�(S'�l �L'��' Cert.Tester N�J��'f�D�� Date � *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE � The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION A5SEMBLY TE5T AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) C� � � � � r /j p J �� c� MAILING ADDRESS: � S-�� ll�� a�� , CONTACT PERSON/PHONE: ��3�� 5�3� LOCATION OF SERVICE:��,,� t The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle ❑Reduced Pressure Principle-Detector j�oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker �� Manufacturer C'� Model NumberT��L 1�3 Size�_ Located At 1�'� ��" Y�(�✓� �f C � � Serial Number �� C`�.��,�_ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight;'�' Closed Tight � psid psid psid Leakedn Leaked❑ Did not open ❑ Did not open ❑ Leakedf7 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight��7 Closed Tight❑ ps�d psid psid Test gauge used:Make/Model� ��e��J�.`�"��,�5 `� SN: L��f ��' �� Date Tested for Accuracy: Z l Z � � 7 Remarks: The above is certified to be true at the time of testing. Firm Name��'f�''b c� /'►�1y�1 , Firm Addres�Cjl,� �2(s��YC,�/D t01�b (jr �lC�s'� Certified Tester(print)�C�V'tJ��fl l�12� Certified Tester(signature) � -� C Firm Phone# l 7�-Q�� Cert.Tester No��,�Date � * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE V The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. #0570040 (Customer) ) I ,p MAILING ADDRESS: ��ri.1��Si !1(.' � �P)'��Z(�� c��f'E1�l�G� , 7'SG f cl CONTACT PERSON/PHONE: �j � �. �C?`� `�_3 b LOCATION OF SERVICE: �i�,n� � The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle ❑Reduced Pressure Principle-Detector q�SoubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker �1Spi11-Resistant Pressure Vacuum Breaker Manufacturer i'�l� S Model Number � !'J��l�_Size .� �� Located At � 1� S�' Y ��()�,,��_Serial Number�L� ()�S � Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held a��psid Held at��U psid Opened at Opened at Held at Initial Test Closed Tigh� Closed Tight � psid psid psid LeakedC Leaked'�', Did not open '�J Did not open ' ; Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight�.1 Closed Tight'i l psid psid psid Test gauge used: Make/Model�i(��I�S l� O ��" S SN:��L''��/ Date Tested for Accuracy: 2. l ��/ 7 Remarks: The above is certified to be true at the time of testing. FirmName ��(G'��U CCJ/✓ty!/t. Firm Addres�C�%3 ��'��D�U'l'hC � �� Certified Tester(print��'� �tX�c-/�Us,�/ Certified Tester(signature) Firm Phone# C�'� Cert.TesterNo��`Gf� Date �� *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE ✓ The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: !a-��S/�l�� C'e ��el�(,?c/��C�,,17pe/��1 �.� 7�L' /�� CONTACT PERSON/PHONE: �j 7_;Z 3 G � <�� 3 � LOCATION OF SERVICE: S� ►�►t P The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �❑R duced Pressure Principle CiReduced Pressure Principle-Detector ouble Check Valve �J Double Check-Detector ❑PressureVacuumBreaker [7Spi11-Resistant Pressure Vacuum Breaker ��l Manufacturer �,� Model Number � �CL�y� Size Located At � /�S C � �� -� Serial Number �� /�� 'j Is the assembly installed in accordance with manufacturer recommendations and/or local codes? ;�r�� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at � psid Held at��7 psid Opened at Opened at Held at Initial Test Closed Tight��7 Closed Tight � psid psid psid Leaked�C�' Leaked�� Did not open � Did not open 'J LeakedC Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight❑ psid psid psid Test gauge used: Make/Model �•'Gt�J�CS 1� �7 J ~� SN:(t�G ��G'�.� � Date Tested for Accuracy: Z��Z'7�/'� Remarks: a �j/'c �7 r o i��"�� i'!' The above is certified to be true at the time of testing. FirmName �c� �1�'L" l--L'iyr/yt Firm Address��`�/��7 �'�''�GVf jlc� � (�L'�� Certified Tester(print),2'Y'G/��(f,�Certified Tester(signature) � Firm Phone#�� t y ��L�� Cert.Tester No.'J/��Date�,�/�,7 *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy � IRRIGATION DOMESTIC FIRELINE]� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: G�,.,k��`c�� Q C�.��<�20�(l C�,,�h�� G" ��' CONTACT PERSON/PHONE: �j 7 Z �('; Z_T�1 3 � LOCATION OF SERVICE: ,Si�� " The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �❑ duced Pressure Principle ClReduced Pressure Principle-Detector ouble Check Valve ❑Double Check-Detector !7PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker 2��'�-' / Size �� Manufacturer ��/?/1 � S Model Number 3 Located At �� S� r �l�� .3� Serial Number [�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? � Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve l st Check 2nd Check Held a�� psid Held a�� psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight �' psid psid psid Leaked[J Leaked�-' Did not open '� Did not open �l Leaked�� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight❑ psid psid psid Test gauge used:Make/Model °�[�t ,�s� �L�� SN:G�_�C�y��S�� Date Tested for Accuracy: ,2 ,Z� �� Remarks: The above is certified to be true at the time of testing. FirmName �G fYG � � ��) Firm Address i�� j�� `X��l✓� � l� ��C�� Certified Tester(printl eY'i;lC��'�L^C�Certified Tester(signature) �� Firm Phone# 7Z � �� '� l�G�'� Cert.TesterNo ��`�� / Date �(�4 �l� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE �✓ The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) q MAILING ADDRESS: �a k�.S��c�� CUt��'�� v�'CoP��I� � �f��/ CONTACT PERSON/PHONE: 9��./' �f �-/� 3 t� LOCATION OF SERVICE: �S� ►.- � The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle f7Reduced Pressure Principle-Detector �ouble Check Valve ❑Double Check-Detector ❑PressureVacuumBreaker �JSpill-Resistant Pressure Vacuum Breaker J! Manufacturer �� _Model Number�� Size i� ' �� r�v�-, 13��- ��1�;3 Located At Y' f S S � � Serial Number Is the assembly installed in accordance with manufacturer recommendations and/or local codes? � Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at/�psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight,� psid psid psid Leaked`�l Leaked'-� Did not open !� Did not open '� LeakedCl Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight❑ psid psid psid Test gauge used:Make/Model � G�6✓G' t ��J �J SN:��c�� Date Tested for Accuracy: 2 Z- / Remarks: The above is certified to be true at the time of testing. FirmName��l`�C ��,''�/d�l Firm Address/��Z �'� �''►�L� ��,iiit �� ---r Certified Tester(printl,�!'�� CCK Certified Tester(signature) � � � Firm Phone# '�- � 7��'� Cert.Tester No�i�v0�8�� 7 Date ��Z� /l� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE V The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) / / MAILING ADDRESS: L��C S��'lP C� C�r PI'�J�� C b p p,:1C�'� 7s��S CONTACT PERSON/PHONE: �i � 'L � L�� L " ��° LOCATION OF SERVICE: ��:►v� �� The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑R duced Pressure Principle i�Reduced Pressure Principle-Detector �oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker OSpill-Resistant Pressure Vacuum Breaker �-� 2�� _ Manufacturer � ��` Model Number Size Located At �'1 S� � �G U/!�r �� ,�_Serial Number �(�/)� S �� Is the assembly installed in accordance wrth manufacturer recommendations and/or local codes?�9-t Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at1�psid Held�� psid Opened at Opened at Held at Initial Test Closed Tigh� Closed Tight F!� psid psid psid Leaked'�:7 Leaked`1 Did not open Cl Did not open ��7 Leaked'� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight�l Closed Tight❑ psid psid psid Test gauge used: Make/Model/'l' �/`G✓�f� ��l��J SN:��1 L��'�.�C' Date Tested for Accuracy: � / Z � /!7 Remarks: The above is certified to be true at the time of testing. FirmName �/' ��G L.�G'/YlI't') � Firm Addres�C!✓1�(l ,C�Y4� ��YtG��'CJ7� Certified Tester(print}.��r U/GC J C/`?�`�/— Certified Tester(signature) n � '"!�— , Firm Phone# �Z�,�J �� Cert.Tester No. G�'�� Date * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy �� IRRIGATION DOMESTIC FIRELINE V The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 MAILING ADDRESS: �-4�e 5 � rJ� � C u('r c ��lY-��i� �cr F�'� �/ �� 7S(?l� CONTACT PERSON/PHONE: 1�,Z 3� � �� LOCATION OF SERVICE: _S"; -�-� C The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑ duced Pressure Principle ❑Reduced Pressure Principle-Detector �ouble Check Valve ❑Double Check-Detector ❑PressureVacuumBreaker i7Spi11-Resistant Pressure Vacuum Breaker /� l� Manufacturer /7 !'� C-5 Model Number 2 �G�) � Size�_ Located At Y I � ('. Y �a G}� �(� -�� .� Serial Number 6`j��° Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve l st Check 2nd Check Held at �(�' psid Held at�/( psid Opened at Opened at Held at Initial Test Closed Tight?''� Closed Tight � psid psid psid Leaked❑ Leaked;_i Did not open �� Did not open '�.1 Leaked��-� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight[1 Closed Tight❑ psid psid psid Test gauge used:Make/Model/�/✓lS��✓G'�1� ��S" � SN: ��Q y�J�.�C� Date Tested for Accuracy: ,Z (z„_? / /� Remarks: The above is certified to be true at the time of testing. Firm Name Q ��C� [';jy�N'1 Firm A ddress�L ��t'7(.,'a'G.R'�v%nG[x��L�� Certified Tester(print)„�C!Y_r./L��C/Z L�G�� Certified Tester(signature) � Firm Phone# y 7 ,2 � � � � �� Cert.Tester No�G'v�/��i�e 4 Date.J `�<D / � *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) � ,�� C� . ,r)� / �� MAILING ADDRESS: l �.. r S� � `'� � pP�� ^�� 1� Cu✓'PE�/ �1 CONTACT PERSON/PHONE: �j 7� �d �/ l i S 3 r`} LOCATION OF SERVICE: ,S� . ^� The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle ❑Reduced Pressure Principle-Detector �15oub1eCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker �lSpill-Resistant Pressure Vacuum Breaker /� , �< Manufacturer /`I h�? �'S Model Number 2 ��C'�� Size � Located At Y►��' � ��l�i_� � �/ Serial Number ��_cJ.3 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? � Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held a��U psid Held a��F psid Opened at Opened at Held at Initial Test Closed Tight�' Closed Tight � psid psid psid Leakedr� Leakedl�': Did not open `� Did not open ❑ Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight�] Closed Tight❑ psid psid psid Test gauge used: Make/Model j� �' C � (� �r�`s` SN:��Q�G�� Date Tested for Accuracy: 7 Remarks: The above is certified to be true at the time of testing. FirmName�G �'�J �Uls'►`� . Firm Address��O�/� �� yk�(,'i'hG l��C(��/ ified Tester rint �C'rt%�� G� Certified Tester(signature) �!��`Z.�� Cert (p ) l � Firm Phone# p L��? Cert.Tester No��L�� Date � / l *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy �— IRRIGATION DOMESTIC FIRELINE ✓ The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILnvG ADDRESS: �-a s� d��% C��,��C��(l� C�nrc/�� .SG� �i CONTACT PERSON/PHONE: 5 7�(n Lr �L� .�c LOCATION OF SERVICE: � t' The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Rf duced Pressure Principle C!Reduced Pressure Principle-Detector �'DoubleCheckValve '�Double Check-Detector [�PressureVacuumBreaker �-iSpill-Resistant Pressure Vacuum Breaker l �( Manufacturer �7'�I?/I P 5 Model Number �� Size � Located At �L, ? � �!�!'1� /�/�i � 7 Serial Number�L�� t�-/ � �' Is the assembly installed in accordance with ma acturer recommendations and/or local codes? i�('S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�psid Held at � psid Opened at Opened at Held at Initial Test Closed Tightf-1 Closed Tight ��-; psid psid psid Leaked;� Leakedy Did not open .� Did not open '.1 Leaked�� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight�I Closed Tight I�' psid psid psid Test gauge used:Make/Model �j� � �f �(C� � O C��"J SN��4 �' L�� Date Tested for Accuracy: ��7 � � Remarks: i� �% G The above is certified to be true at the time of testing. Firm Name �"/ �' f�� /�'►J'� � Firm Address��l,z�f��'C.D�V��/X�Gi �� Certified Tester(print)��a"� I��C/2��C'll�� Certified Tester(signature) Firm Phone# �� Cert.Tester No��GC� ��E l�j Date �.�� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy / IRRIGATION DOMESTIC FIRELINE V The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) f p MAILING ADDRESS: ��rr.�C ��pPc I(�iZCi/��u Gy1�;ll��1 ��Q/ � CONTACT PERSON/PHONE:�i 7�Z �Q�1 Lf�i Q LOCATION OF SERVICE: S� � r The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY I�Reduced Pressure Principle `-1Reduced Pressure Principle-Detector �oubleCheckValve C;Double Check-Detector ❑PressureVacuumBreaker '"_1Spi11-Resistant Pressure Vacuum Breaker 11 Manufacturer !�'� � 5� Model Number �� Size � Located At �^y,S_ �✓' �''l.�C'i�''Z'l ! �� Serial Number �nL� �5 ,��_ I s t h e a s s e m b l y i n s t a l l e d i n a c c o r d a n c e w i t h m a n ufacturer recommendations and/or local codes?;�S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held a�'� psid Held at l/� psid Opened at Opened at Held at Initial Test Closed Tight�?� Closed Tight,i7�' Psid psid psid Leaked�.1 Leaked�' Did not open � Did not open '-; Leaked'�' Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight�J Closed Tight� psid psid psid Test au e used: Make/Model � �� `/ SN:L��l %.�� _ � � Date Tested for Accuracy: ��,`2_�� Remarks: The above is certified to be true at the time of testing. FirmName /� /!" ��i� �f1/d/YI Firm Address�%��2�7 ��V/ t ��7 Certified Tester(print��'r��/c��C� :��Certified Tester(signature) �-- Firm Phone#�7��F�� 75 /�� Cert.Tester N� '' � � � Date .S � *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE V The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) , �� / '/ G MAILING ADDRESS: L�J�—cS/��'� �'P�'L�(��C�'�+ CGO��'Gf�l�� SG' � / CONTACT PERSON/PHONE: � 7�,�C'� � � LOCATION OF SERVICE: ��vn,�' The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ��1Reduced Pressure Principle ❑Reduced Pressure Principle-Detector �DoubleCheckValve f7Double Check-Detector �PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker 1► Manufacturer �� Model Number ��L�' � Size � Located At �� 'S�, ✓?��°(�l� �(�i '7 � Serial Number�L*L �� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? r' Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at/� � psid Held at�+� psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight-� psid psid psid Leaked"! Leaked' '� Did not open f ' Did not open �7 Leaked'.i Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight�l Closed Tight'��! psid psid psid Test gauge used:Make/Model�"l?��i(��n_s�1 L1.5 `S sN: a 8C'L��'�.�� Date Tested for Accuracy: ,,�/� �/ � 7 Remarks: The above is certified to be true at the time of testing. Firm Name /r/C f`�''L� �G`n'1� � Firm AddresspG/�3�2(7 C--1"t�D�Oj/j h.'r �y'/�`�f� Certified Tester(printk�G�E��C�/L�� Certified Tester(signature) z-- C Firm Phone# � � ��"� Cert.Tester No� �'�� Date�� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE � The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) , � .� MAILirr�aDD�ss:G,�.k�,�'_�� CG n�r�//�zC/1�. ��'��f� ��I� CONTACT PERSON/PHONE: G �,�,3 C;�l Ll � �� LOCATION OF SERVICE: �S Y�� The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY [��duced Pressure Principle ;�Reduced Pressure Principle-Detector �iDouble Check Valve �I Double Check-Detector �1PressureVacuumBreaker '��1Spi11-Resistant Pressure Vacuum Breaker Manufacturer /Z'? � _� Model Number�� L�� ,!�) Size 2 1� i �Q Located At Y 1 S� h� T 0()rn ,�_�_`J CL Serial Number �U�/y�� Is the assembly installed in accordance with manufacturer recommendations and/ar local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at��psid Held at�� psid Opened at Opened at Held at Initial Test Closed iT ght� Closed Tight i� psid psid psid Leaked�-1 Leakedl-i Did not open '-�� Didnot open Cl Leaked��] Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight 17 Closed Tight C� psid psid psid Test gauge used:Make/Model /`�rf � �G SN:�%D�� C�� Date Tested for Accuracy: z / 1 Remarks: The above is certified to be true at the time of testing. Firm Name��f'✓�) �G1'Y►112 Firm Address! l�/� f��Y►�� C �''t��F l X �� Certified Tester(print)��'�� C��e�l'e�� Certified Tester(signature) � Firm Phone# �� 2 � � �7 d�� Cert.Tester No�pG�� v � Date * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE � The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. #0570040 (Customer) ,� Q � � � ,� ! U 1/�� 7�G'� MAILING ADDRESS:�v� �/' S: G C� �P �� Z U/V.�' `n��r CONTACT PERSON/PHONE:_��U�( G� �f �C LOCATION OF SERVICE:_��,�� The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY I�Reduced Pressure Principle ❑Reduced Pressure Principle-Detector �ubleCheckValve -1Double Check-Detector C]PressureVacuumBreaker ��Spill-Resistant Pressure Vacuum Breaker } � li Manufacturer �7"/�'��,� Model Number �L�i�� /� Size Located At �''J��'. Y' 1��G/� �, /4' �� Serial Number ��'�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes?��S' Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�psid Held at/�� psid Opened at Opened at Held at Initial Test Closed Tight�' Closed Tight iY psid psid psid Leaked',�' Leaked� Did not open �l Did not open ❑ LeakedC Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight� Closed Tight'�7 psid psid psid /�' � � Test gauge used:Make/Model t 'Gf � ` SN:C"��/ �' Date Tested for Accuracy: Remarks: The above is certified to be true at the time of testing. FirmName_�"�tr� �6 /Yt12�- Firm Address�(�'�5�2� �L-�-1'4.tiAcv�r�c��' 7�€ �� j J ^ , J )� Certified Tester(print)J L�r c /�t'fL fL6L�!� Certified Tester(signature) Firm Phone# 7��CL/ ��1 Cert.Tester No. L�L�' Date � * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) � � MAILING ADDRESS: G�C•.T�e��c � �'��r�ll G �'�� C nr�1/ �� 7Sc�/ � CONTACT PERSON/PHONE: Gi �y �J ��[% LOCATION OF SERVICE: ��5�tz.� The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle ❑Reduced Pressure Principle-Detector ��oubleCheckValve �:iDouble Check-Detector C7PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker ,� 1� Manufacturer_ //�� p� Model Number �� Size � Located At �1�S� � YU(�� /��9 L'�� Serial Number ��i d f'S � � Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �'S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�psid Held at�psid Opened at Opened at Held at Initial Test Closed TightrX Closed Tight � psid psid psid Leakedi'; Leaked�—• Did not open ': I Did not open '�^; Leaked[.' Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight�i psid psid psid Test gauge used:Make/Model �r`l� ,/.� 7� �C� �'-45 srr: �S�� f�' �SG� Date Tested for Accuracy: ,2. �� 7 Remarks: The above is certified to be true at the time of testing. FirmName ��(L`, C�,�I�L/1'J Firm Address �Cr�l��a�GY� �� rt E ��lc �S' Certified Tester(print C�r�, � - Certified Tester(signature) Firm Phone# Cert.Tester No. L� o Date.�/�(G �/ � *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. # 0570040 (Customer) 1� � , MAILING ADDRESS: al�c S� G `�' C G I��° � � �� c�/'I'��7-�� CONTACT PERSON/PHONE: L � � �L LOCATION OF SERVICE: ,�, i � The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �lReduced Pressure Principle '�Reduced Pressure Principle-Detector I�ouble Check Valve i;Double Check-Detector f iPressureVacuumBreaker �iSpill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number � L'L�C�T_Size�_ Located At ��e.�r�G%J''riJ ��i G'�� Serial Number � I�[; .�) Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �P Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held�—p/sid Held at/�psid Opened at Opened at Held at Initial Test Closed Tighti_� Closed Tight .� psid psid psid Leaked'�; Leaked'-, Did not open '� Did not open -� Leaked'�I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight� Closed Tight� psid psid psid Test gauge used:Make/Model ��, �ll��S 7' ��f'� SN: d �� C� �� Date Tested for Accuracy: �l z`� ( 1 7 Remarks: The above is certified to be true at the time of testing. FirmName /v(��4"�� "1/v► Firm AddressJ Lf�>�� -rK`�rC v��` c/k �� Certified Tester(print}��Y C�L��l�CYS� Certified Tester(signature � � Firm Phone#� �� %�'� Cert.Tester No��(1C�(�� Date * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE �� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 Malinvc a��ss: �a k�3-��'��C C�pp�J/(��ZC'�l�,C� ��c 1 jf��. ��SG l�1 CONTACT PERSON/PHONE: �j 7;2 3C� �5 ��` LOCATION OF SERVICE: � i+-,G The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY -1Reduced Pressure Principle ';�Reduced Pressure Principle-Detector �lbouble Check Valve ❑Double Check-Detector [�PressureVacuumBreaker �_iSpill-Resistant Pressure Vacuum Breaker Manufacturer �"itit�' S Model Number -2�'��1 � Size ��. Located At � l � �' �"�C�� =7�Serial Number OG 0>�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes?o.� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at//UJ psid Held at/�psid Opened at Opened at Held at Initial Test Closed Tigh� Closed Tight.Y� psid psid psid Leaked'I_� LeakedC Did not open ❑ Did not open �J LeakedC' Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight❑ ClosedTight❑ psid psid psid Test gauge used:Make/Model /"(z' '�G�C, r � L SN: C 5'C� y �� Date Tested for Accuracy: � i�7 /! � Remarks: The above is certified to be true at the time of testing. Firm Name�C". tr� �U/�>"'1 , Firm Address/�L�,�l.?��G�rr�✓� uih� T 7 p 0 � / <� / f � Certified Tester(print��'r�/�/C�?d�/� Certified Tester(signature)`� Firm Phone#��LG�� l��G�� Cert.TesterNoc,�C%G�`�(c��Date � .2 ' � *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS ' **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy I IRRIGATION DOMESTIC FIRELINE `�" The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) / � MAILnvG ADDRESS:��, � �P, C�j.��tl/��C?/1/�i^P�C/(l`c1� ��C''/9 CONTACT PERSON/PHONE: �j_'j z 3 �`� Y ,.,5 G' LOCATION OF SERVICE: Sc�mC The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle C,Reduced Pressure Principle-Detector �ouble Check Valve '��Double Check-Detector f"7PressureVacuumBreaker 'f��Spill-Resistant Pressure Vacuum Breaker �t Manufacturer � �S Model Number ��i L� L � Size � Located At �) ��1� YCa� lC; �� Serial Number (�� 3 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? � Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check � Held a�psid Held a�l � psid Opened at Opened at Held at Initial Test Closed Tight;� Closed Tight —' psid psid psid Leakedi.] Leaked�� Did not open ��-1 Did not open ��1 Leaked�1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight'7 ClosedTight�7 psid psid psid Test gauge used:Make/Model �� l� ��l ��r S`,� SN: �� G y�' ��C Date Tested for Accuracy: 2 �7 / / � Remarks: The above is certified to be true at the time of testing. Firm Name � � �t'C �U f1'1/YI. Firm A ddress�l��7 Grc.�c�v1h c �7�Zf�G��/C (p )�e•r�� j Certified Tester(signature) - C- Certified Tester rint Firm Phone# / /��G�� Cert.Tester No1�pG CG�(�,(�� Date . *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) � �q MAILING ADDRESS:L-�� L'' w Co i� ��i �.C�I�� L '� n fC'f CONTACT PERSON/PHONE: � 7 ° � �� C LOCATION OF SERVICE: St�,m ►'` The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑R�duced Pressure Principle f 1Reduced Pressure Principle-Detector �oubleCheckValve �;Double Check-Detector ��]PressureVacuumBreaker r��Spill-Resistant Pressure Vacuum Breaker �� Manufacturer i2 Model Number �(�'�� Size � '_�____� < <� ��y DC��s��- Located At V��?� �c9 G h�t Serial Number � _ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check a Held at 1 psid Held a�� psid Opened at Opened at Held at Initial Test Closed TightFi' Closed Tight i� psid psid psid Leaked��l Leaked'��_, Did not open ��-1 Did not open '� Leaked:� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight 7 Closed Tight'Ll psid psid psid Test gauge used: Make/Model ��cs f �`�S � srr: C� �c� y��S�� Date Tested for Accuracy: �2 /2 '7 �� 7 Remarks: The above is certified to be true at the time of testing. FirmName�/�l'L} CC1 �'I/Z'1. Firm Address�l��Crr�.►��:�✓�`lZ��c�j�/ Certified Tester(print}��"rv/G��GC� Certified Tester(signature) .� � � � � Firm Phone# J�� . � �� Cert.Tester No�/"l,Y�G��!'� Date �/��/l 7 * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS i White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE �/ The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) MAILING ADDRESS: �i' C,��+� �CG P�'�'�1 Ct„ZC'/J� A°�'Y��f��G�7 S C-/�j CONTACT PERSON/PHONE: ��,Z '�y T�j'.� � LOCATION OF SERVICE: S<.,� � The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �❑R duced Pressure Principle �Reduced Pressure Principle-Detector ouble Check Valve ❑Double Check-Detector ❑PressureVacuumBreaker :�Spill-Resistant Pressure Vacuum Breaker ? l Manufacturer �� Model Number ��C�� ) Size� Located At �i S�'� l'�G�7''1 �� Serial Number��CfJ ,L�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes?�uF.S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�i' � psid Held at/i� psid Opened at Opened at Held at Initial Test Closed Tighty?" Closed Tight � psid psid psid LeakedC-� LeakedCl Did not open � Did not open ! J LeakedL! Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight❑ psid psid psid � Test gauge used:Make/Model l �`!X �� ' 7` � �`� SN: Q�(1 ��L' Date Tested for Accuracy: I Remarks: � The above is certified to be true at the time of testing. i FirmName �r f�v ��=�/�..� Firm Address�G��.�e7��(�'�'U IL4/�( ��G' J� � j Certified Tester(print)��'YD��ChGyC� Certified Tester(signature) � � Firm Phone#� �� Cert.Tester Ndr'�C�t-?��(�J Date �� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS i **USE ONLY MANUFACTURER'S REPLACEMENT PARTS � White-City Copy Yellow-Customer Copy Pink-Tester's Copy i